The objectives of this cross-sectional study were to examine the performance of the District Health Boards (DHBs), and to investigate factors affecting DHB performance within the district health system in Chiang Mai Province, Thailand. The samples of the study were 399 participants from the DHBs. The data were collected by using a questionnaire. The collected data were analyzed with descriptive statistics (percentage, mean, and standard deviation) and inferential statistics (stepwise multiple regression analysis). The study’s results showed that the overall DHB performance within the district health system was at a moderate level (mean = 3.38, S.D. = 0.79). Among the components, the highest mean was found for setting objectives and plans at a high level (mean = 3.52, S.D. = 0.69), while the lowest mean was found for the evaluation of sustainable work development at the moderate level (mean = 3.17, S.D. = 0.70). Regarding factors affecting the DHB performances, eight co-predictive variables were found: 1) internal communication, 2) DHB potential development, 3) work assignment in teams, 4) community participation, 5) teamwork, 6) management experiences, 7) status of divorce/widow/se
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